Provider Demographics
NPI:1649062852
Name:KODDO, OMAR ABDUL RAHAMAN
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:ABDUL RAHAMAN
Last Name:KODDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 S 131ST ST APT 7
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1848
Mailing Address - Country:US
Mailing Address - Phone:832-949-5025
Mailing Address - Fax:
Practice Address - Street 1:4817 S 131ST ST APT 7
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1848
Practice Address - Country:US
Practice Address - Phone:832-949-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide